Palliative onkologische Chirurgie am oberen Verdauungstrakt - Stellenwert in Zeiten multimodaler Therapiekonzepte?

Zusammenfassung

Der Stellenwert palliativer Chirurgie bei Tumoren des oberen Gastrointestinaltraktes wird in erster Linie relativiert durch endoskopische und perkutan interventionelle Verfahren. Damit kann bei Ösophagus-, Pankreas- und Gallengangskarzinomen in der überwiegenden Mehrzahl der Patienten eine gute Palliation mit niedrigem Risiko erreicht werden. Die Indikation zur palliativen Resektion ist beim Magenkarzinom weiter zu stellen, da das perioperative Risiko geringer ist und die palliativen Effekte bei Blutung, Stenose, Tumorzerfall und Perforation insbesondere bei einer Lebenserwartung von noch ca. 6 Monaten besser sind. Die neoadjuvante Radio-/Chemotherapie verändert den Wert der palliativen Chirurgie bei oben genannten Tumoren nur in dem Maße wie die lokale R0-Resektionsrate gesteigert werden kann. Diese Effekte sind zur Zeit beim Ösophaguskarzinom am deutlichsten. Bis erfolgreiche kurative Behandlungen für Patienten mit fortgeschrittenen Tumoren verfügbar sind, müssen palliative Verfahren weiter verbessert und adäquat angewendet werden.

Abstract

The significance of palliative surgery for tumors of the upper gastrointestinal tract is mainly restricted by endoscopic and percutaneous interventional procedures. By these means a good palliation with low risk can be achieved in the majority of patients with oesophageal, pancreatic and biliary carcinomas. In gastric cancer the indication for palliative resection is more extensive because the perioperative risk is lower and the palliative effects in case of bleeding, stenosis, tumor necrosis and perforation especially for patients with a life expectancy of about 6 months are more favourable. Neoadjuvant radio-/chemotherapy changes the significance of palliative surgery in upper GI-tumors only to the extent that the local R0-resection rate can be increased. Currently these effects are most significant in oesophageal cancer. Until effective treatments for advanced staged patients become available, palliative procedures must be further improved and appropriately implemented.

Schlüsselwörter

Palliative Chirurgie - oberer Verdauungstrakt - Malignome - multimodale Krebstherapie

Key words

Palliative treatment - oncologic surgery - upper gastrointestinal tract - multimodal cancer therapy

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